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Making effective practice decisions

Decision-making in the practice is littered with pitfalls. Fiona Dalziel has advice on getting it right.

Chairing a meeting: effective decision-making depends on effective chairmanship (Photograph: Istock)
Chairing a meeting: effective decision-making depends on effective chairmanship (Photograph: Istock)

Here are a few phrases you may have heard at your practice: 'I don't remember us saying we would do that'; 'Well, nobody told me' and 'Sorry, we talked about it over coffee one day last week and decided that it was the best plan.'

If they sound familiar, the practice's decision-making processes would possibly benefit from being refreshed.

Establishing a process
If everyone in the team knows how decisions should be made, then items needing discussion will not be 'lost' and the incidence of decisions made 'on the hoof' will reduce.

Here are the key steps for setting up a process that the team should stick to:

  • Review and clarify the purpose of each regular meeting - who should attend, how often it meets, when, for how long, who chairs it and the extent of the group's decision-making authority.
  • Consider the following types of decisions in your review:
    - Strategic.
    - Important or major but not urgent.
    - Important or major and urgent.
    - Not important or major but urgent.
    - Affect day-to-day service delivery/operational.
  • Put together a decision-making chart and post it somewhere prominent. List a few examples of the type of agenda items dealt with at each decision-making level.
  • Clarify the process for adding items to agendas.
  • Explain the process for feeding back decisions made and actions to be taken.

Putting a chart on the wall will not ensure that people either look at the chart or comply with the process.

The meeting's chairperson and the person drawing up the agenda have responsibility for ensuring that their group is the right forum for a particular decision.

You should regard decisions made outside this process as having no standing unless there are exceptional circumstances.

 Common pitfalls

Absentees/information lacking: 'The right people or information were not there for a decision to be made.' Remember to devote time to the planning process before the meeting.

Too much rescheduling: 'We keep having to change the date.' Agree dates as far in advance as possible and stick to them unless there is a really strong reason to change.

Unwilling participants: 'One partner frequently cries off at the last minute. Or doesn't contribute if present and sabotages the decision later.' Establish a culture where being at the meeting is seen as important and worthwhile. The chairperson must ensure that this person contributes to discussions at meetings and that they receive minutes. Discuss with them privately reasons for disagreeing or not complying.

Planning ahead
Whatever the decision-making process, it will fail if these underpinning functions are not in place.

  • Agenda preparation:
    - Give participants a reminder and deadline for adding items to the agenda.
    - Include items from previous minutes.
    - Prioritise so that important/urgent/complex items are discussed first.
    - State whether an item is for information only or for discussion/decision.
    - Identify the lead person and rough timings for each item. Agree the finish time.
    - Include suggested dates of next meetings.
    - Try to get the agenda out in advance of the meeting.
  • Documents needed:
    - Complex/major decisions may need to be supported by a paper explaining the issues.
    - Distribute papers in advance together with the agenda to allow people attending the meeting time to think beforehand.

Chairing meetings
Effective meetings and decision-making depend on effective chairing. The chairperson is responsible for:

  • Introductions, if appropriate.
  • The meeting's structure, including any invited participants and their roles, and the finish time.
  • For each item, summarise the discussion, ensure everyone is clear on what was agreed, who is responsible, and what the timescale for action is.

The chairperson should be objective (and delegate their role for any item that impacts strongly on them personally).

The chairperson should:

  • Agree the type of decision required - unanimous/majority/consensus.
  • Keep the discussion focused on the topic and manage it so that important points are not forgotten.
  • Be sensitive to everyone's feelings.
  • Not dominate or make all decisions personally.
  • Retain control of the meeting, keeping to time as much as possible.
  • Be alert for body language, such as dissent and tiredness.
  • Ensure the views of less vocal participants are heard and that more vocal participants keep to the point.
  • Resolve conflict.
  • Avoid a false consensus.

Taking minutes
People may not have been at the meeting but need to know what was decided. At some point, you may need to look back and clarify what went on.

The person taking the minutes should not chair the meeting and they need to know what they should record - detailed discussion points or a summary of the discussion, the decision made and any deadline(s)?

Help the minute-taker to get the minutes out fast. Consider having a template so that they can input the information directly into a laptop at the meeting.


These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • List recent incidences of decisions made at your practice without adequate discussion involving those affected. What was the result?
  • Review any written policy/procedure on decision-making (including the partnership agreement). How could it be improved?
  • Present a paper on how practice decision-making could be improved at a meeting you organise along the lines above of all (appropriate) team members.

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